Doug Nicolle, St. Paul’s Hospital’s media producer, watches a video recording of a heart-valve replacement procedure on one of the big screens in the hospital’s Virtual Heart Lab.Photo by
Jason Payne

Technological wizardry at St. Paul’s Hospital extends far beyond the world-class surgical facilities. Hospital staff have developed high-tech capabilities for multimedia education, and for saving the lives of heart-attack victims.

To solve the problem of visiting doctors congesting operating rooms while observing cutting-edge surgeries such as Dr. John Webb’s revolutionary heart-valve replacements, and to allow the hospital to send live video of procedures all over the world, hospital staff created the Virtual Heart Lab.

A dozen monitor screens line the lab’s studio, which contains two editing suites filled with computers, speakers and mixing boards. Images from operating-room cameras and five different types of imaging devices such as ultrasound can be beamed live, in high definition, into a screening room, so observing physicians don’t clutter up the operating room and create safety hazards.

“People sitting here watching these screens see exactly what Dr. Webb sees in the OR,” says St. Paul’s media producer Doug Nicolle. Cameras in the OR can be zoomed in for close-ups on the surgeon’s hands.

For larger groups of medical visitors, live surgery can be transmitted to a lecture hall holding up to 180 people, or to conferences around the world where up to 5,000 cardiac surgeons may be watching.

“It’s live television. It looks eye-searingly real,” Nicolle says, adding that Webb can even answer questions from conference panellists while he’s operating.

Surgery footage is also edited down to eight to 10 minutes for presentations at conferences.

Another technological advancement at St. Paul’s is drastically improving patients’ heart-attack survival outlook.

The shorter the time between heart attack and treatment, the more likely a patient is to survive, the less their heart will be damaged, and the faster they recover. Two Vancouver doctors have pioneered a practice that saves an average of half an hour per patient.

The need to cut that time is clear: 300 people in the Vancouver Coastal health region suffer massive heart attacks — in which a clot completely blocks a blood vessel of the heart — each year, with 700 more from the Fraser Health region, and a total of 1,200 to 1,500 across B.C.

“The race is to try to open up that clot,” says Dr. Krishnan Ramanathan, St. Paul’s cardiac intensive care director.

Before Ramanathan and Vancouver General’s Dr. Graham Wong devised and implemented their treatment innovation, heart attack patients would arrive at hospital and immediately be given an electrocardiogram (ECG) — a scan which can locate death-dealing blockages in coronary arteries. Or, if the patient had been transported in an ambulance equipped with an ECG machine, the printout would be handed over to medical staff at the hospital doors. Then a doctor would make a diagnosis, a treatment team would be assembled, and the life-saving would begin.

Now, thanks to Ramanathan and Wong, 10 ambulances serving St. Paul’s and VGH carry the technology and equipment to remotely transmit ECGs from the ambulance to emergency rooms. With information from the paramedics on the road, and the transmitted ECG results, a doctor can make a diagnosis and gather a treatment team before the patient arrives.

Patients then receive clot-busting drugs and surgery, if needed, immediately. The innovation, implemented in 2008, has cut average per-patient time between heart attack and treatment by 30 minutes, Ramanathan says.

The practice was developed after the doctors contacted U.S.-based medical-technology firm Medtronic.

“We said, ‘You’re the smart people about electronic things, produce something that can be used.’ This technology has to be very robust — it can’t fail. Space within an ambulance is limited. We had to develop something small.”

In addition to training paramedics to use the system, the doctors worked with ambulance dispatchers on a protocol to ensure patients who need it are picked up by an ambulance carrying it. Dispatchers were trained to listen for key phrases such as “chest pain” and “shortness of breath,” and send the right ambulance and paramedic team for the job.

Medtronic and the doctors piloted the technology at St. Paul’s. Fraser Health has now adopted it, and Ramanathan and Wong are working to spread it all over B.C.

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